Gaps in Treatment and Diagnosis of Childhood Sleep-Disordered Breathing

Sleep apnea and other sleep disorders are usually conditions found in adults; however, children are also suffering from sleep-disordered breathing, which may be affecting their overall health and behavior. Usually, enlarged adenoids and tonsils cause the breathing problems in children because they block the airways; this is called obstructive sleep-disordered breathing (oSDB). The condition has been a hot topic of discussion and research for the last ten years. Most children suffer from mild forms of oSDB; however, more severe forms will require surgery to remove the tonsils and/or adenoids.

To gain more insight into oSDB and its prevalence, scientists performed a comprehensive analysis of published research on this topic. By doing this, they identified gaps in the diagnosis and treatment of this condition. All findings were published in the recent issue of the journal, CHEST.

Breathing problems during sleep can vary widely in severity. Some people will have mild snoring and little to no impact on their blood oxygen saturation levels; however, some will have a more severe form of obstructive sleep apnea (OSA). In the latter, children have repeated episodes of restricted breathing that usually lead to a drop in their blood oxygen saturation levels. In 2012, the American Academy of Pediatrics (AAP) issued clinical and treatment guidelines for OSA; however, there is still debate on the best way to treat and manage the condition in young children.

Lead investigator of this research, Dr. Anne G. M. Schilder, from the Ear Institute at the University of College London reported that cases of oSDB in children are on the rise, which may, in part, be related to the increase in childhood obesity rates. Education on the condition has been abundant, so providers and parents are now more aware than ever that this condition can lead to serious health consequences; therefore, they want to emphasize the importance of accurately identifying, diagnosing, treating, and managing this disease using all available resources appropriately. Early intervention and prevention measures may help parents avoid bringing their children into surgery at such an early age.

It’s difficult for primary care providers and hospitals to determine if a child has a mild or severe form of oSDB based on signs and symptoms alone. The gold standard for identifying the severity is a sleep study; however, this can be expensive and not always easily available. Unfortunately, scientists and providers in the medical community are unable to agree on what sleep study results can be interpreted as severe, moderate, or mild and whether a child needs therapy, behavioral treatment, or surgery.

Instead of looking at individual steps in the treatment pathway, there should be a heavy focus on research that looks at holistic approaches, considering the views of all care providers and those involved with the child’s well-being.

To attempt this type of research, Dr. Schilder and her team performed a systematic review of previous research on childhood oSDB. Their goal was to map out the data to better understand the condition. The hope was that findings would lead to evidence that would help in developing guidelines for treatment, find the gaps, and guide additional research. Researchers reviewed upwards of 5700 studies up to November 2015, and they concluded that the research on this topic drastically increased since 2000, with nearly half of the studies (46%) being published since 2011. This was when the AAP released evidence-based data and guidelines for the treatment of childhood OSA.

Analysis Findings

About 61% of the study publications were aimed at identifying the incidence, prognosis, or treatment modalities

Very few research reports (2.7%) looked at health outcomes, service delivery, and economics.

5% of publications were observational studies

Randomized controlled trials made up 2.4% of publications

4% used a qualitative methodology

The recent increase in research around childhood oSDB has enhanced the awareness and understanding of the condition; however, there is a lack of research in health care economics, outcomes, and health services, which impact the relevance of evidence and how it guides treatment. Additionally, this recent research could contribute to the conversation by producing significant questions that can be used in future studies.

This intensive and comprehensive analysis of prior studies opens the door to future research focus points.